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Correlation of Fractional Anisotropy With Motor Recovery in Patients With Stroke After Postacute Rehabilitation

  • Author Footnotes
    ∗ Wen and Alshikho contributed equally to this work.
    Hongmei Wen
    Footnotes
    ∗ Wen and Alshikho contributed equally to this work.
    Affiliations
    Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA

    Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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  • Author Footnotes
    ∗ Wen and Alshikho contributed equally to this work.
    Mohamad J. Alshikho
    Footnotes
    ∗ Wen and Alshikho contributed equally to this work.
    Affiliations
    Transcend Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
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  • Yao Wang
    Affiliations
    Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA

    Department of Rehabilitation Medicine, Nan'ao People's Hospital of Shenzhen, The First Affiliated Hospital, Shenzhen University, Shenzhen, China
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  • Xun Luo
    Affiliations
    Department of Rehabilitation Medicine, Nan'ao People's Hospital of Shenzhen, The First Affiliated Hospital, Shenzhen University, Shenzhen, China

    Kerry Rehabilitation Medicine Research Institute, Shenzhen, China
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  • Ross Zafonte
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA
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  • Martha R. Herbert
    Affiliations
    Transcend Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
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  • Qing Mei Wang
    Correspondence
    Qing Mei Wang, MD, PhD, Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, 96 13th St, Charlestown, MA 02129.
    Affiliations
    Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA
    Search for articles by this author
  • Author Footnotes
    ∗ Wen and Alshikho contributed equally to this work.

      Highlights

      • Fractional anisotropy correlates with the FIM motor score in the good recovery group during postacute stroke.
      • Fractional anisotropy does not correlate with the FIM motor score in the poor recovery group during postacute stroke.
      • Fractional anisotropy may serve as an imaging biomarker during the stroke recovery process.

      Abstract

      Objective

      To investigate the relation between fractional anisotropy (FA), a suggested biomarker for tissue integrity, and motor recovery in patients with stroke after postacute rehabilitation.

      Design

      Retrospective study.

      Setting

      Acute rehabilitation hospital.

      Participants

      Subjects (N=43) diagnosed with ischemic stroke (n=28) and hemorrhagic stroke (n=15). The average age for subjects was 68±14 years.

      Interventions

      Magnetic resonance imaging and diffusion tensor imaging were conducted on all patients.

      Main Outcome Measures

      The admission and discharge motor subscores of the FIM were obtained from medical records, and relative gain was calculated using the Montebello Rehabilitation Factor Score (MRFS). K-means cluster analysis (K=3) using both the MRFS and the gain of the FIM motor subscore (ΔFIM) was performed. Analysis of variance was used to determine the difference in FA among the clusters. Spearman analysis was conducted to examine the relation between FA, ΔFIM, and MRFS in each cluster.

      Results

      FA was significantly higher in the clusters of good and moderate recovery in the corticospinal tract (CST), peduncle, and posterior limb of the internal capsule bilaterally (all P<.05) compared with the poor recovery group. Significant positive correlations were observed in multiple regions along the CST between FA, ΔFIM, and MRFS in the clusters of good and moderate recovery, but not in the poor recovery group.

      Conclusions

      Our results showed an association between FA values within the corticospinal tract and motor recovery in patients with stroke undergoing postacute rehabilitation. This finding may help to identify novel targets for new interventions to promote stroke recovery.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), CST (corticospinal tract), DTI (diffusion tensor imaging), FA (fractional anisotropy), MD (mean diffusivity), MRFS (Montebello Rehabilitation Factor Score), MRI (magnetic resonance imaging), ROI (region of interest)
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